Glaucoma
Glaucoma
Glaucoma
Glaucoma
Acute angle closure glaucoma of the person's right eye (shown at left).
Specialty Ophthalmology
the eye, nausea[1][2]
method
conditions
[edit on Wikidata]
Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss.
[1]
The most common type is open-angle glaucoma with less common types including closed-angle
glaucoma and normal-tension glaucoma.[1] Open-angle glaucoma develops slowly over time and
there is no pain.[1] Side vision may begin to decrease followed by central vision resulting
in blindness if not treated.[1] Closed-angle glaucoma can present gradually or suddenly. [2] The sudden
presentation may involve severe eye pain, blurred vision, mid-dilated pupil, redness of the eye, and
nausea.[1][2] Vision loss from glaucoma, once it has occurred, is permanent. [1]
Risk factors for glaucoma include increased pressure in the eye, a family history of the
condition, migraines, high blood pressure, and obesity.[1] For eye pressures a value of greater than
21 mmHg or 2.8 kPa is often used with higher pressures leading to a greater risk.[2][5] However, some
may have high eye pressure for years and never develop damage. [2] Conversely, optic nerve damage
may occur with normal pressure, known as normal-tension glaucoma. [6] The mechanism of open-
angle glaucoma is believed to be slow exit of aqueous humor through the trabecular meshwork while
in closed-angle glaucoma the iris blocks the trabecular meshwork.[2] Diagnosis is by a dilated eye
examination.[1] Often the optic nerve shows an abnormal amount of cupping.[2]
If treated early it is possible to slow or stop the progression of disease with
medication, laser treatment, or surgery.[1] The goal of these treatments is to decrease eye pressure.
[2]
A number of different classes of glaucoma medication are available.[2] Laser treatments may be
effective in both open-angle and closed-angle glaucoma. [2] A number of types of glaucoma
surgeries may be used in people who do not respond sufficiently to other measures. [2] Treatment of
closed-angle glaucoma is a medical emergency.[1]
About 6 to 67 million people have glaucoma globally. [2][4] The disease affects about 2 million people in
the United States.[2] It occurs more commonly among older people. [1] Closed-angle glaucoma is more
common in women.[2] Glaucoma has been called the "silent thief of sight" because the loss of vision
usually occurs slowly over a long period of time.[7] Worldwide, glaucoma is the second-leading cause
of blindness after cataracts.[2][8] The word "glaucoma" is from ancient Greek glaukos which means
blue, green, or gray.[9] In English, the word was used as early as 1587 but did not become commonly
used until after 1850, when the development of the ophthalmoscope allowed people to see the optic
nerve damage.[10]
Video explanation
Contents
[hide]
Photo showing conjunctival vessels dilated at the corneal edge (ciliary flush, circumcorneal flush) and hazy
cornea characteristic of acute angle closure glaucoma
Open-angle glaucoma is painless and does not have acute attacks, thus the lack of clear symptoms
make screening via regular eye check-ups important. The only signs are gradually progressive visual
field loss, and optic nerve changes (increased cup-to-disc ratio on fundoscopic examination).
About 10% of people with closed angles present with acute angle closure characterized by sudden
ocular pain, seeing halos around lights, red eye, very high intraocular pressure (>30 mmHg), nausea
and vomiting, suddenly decreased vision, and a fixed, mid-dilated pupil. It is also associated with an
oval pupil in some cases. Acute angle closure is an emergency.
Opaque specks may may occur in the lens in glaucoma, known as glaukomflecken. [11]
Causes[edit]
Of the several causes for glaucoma, ocular hypertension (increased pressure within the eye) is the
most important risk factor in most glaucomas, but in some populations, only 50% of people with
primary open-angle glaucoma actually have elevated ocular pressure. [12]
Open-angle glaucoma accounts for 90% of glaucoma cases in the United States. Closed-angle
glaucoma accounts for less than 10% of glaucoma cases in the United States, but as many as half
of glaucoma cases in other nations (particularly East Asian countries).
Dietary[edit]
No clear evidence indicates vitamin deficiencies cause glaucoma in humans. It follows, then, that
oral vitamin supplementation is not a recommended treatment for glaucoma.
[13]
Caffeine increases intraocular pressure in those with glaucoma, but does not appear to affect
normal individuals.[14]
Ethnicity[edit]
Many people of East Asian descent are prone to developing angle closure glaucoma due to
shallower anterior chamber depths, with the majority of cases of glaucoma in this population
consisting of some form of angle closure.[15] Higher rates of glaucoma have also been reported
for Inuit populations, compared to white populations, in Canada and Greenland. [16]
Genetics[edit]
Positive family history is a risk factor for glaucoma. The relative risk of having primary open-angle
glaucoma (P.O.A.G.) is increased about two- to four-fold for people who have a sibling with
glaucoma.[17] Glaucoma, particularly primary open-angle glaucoma, is associated with mutationsin
several genes, including MYOC, ASB10, WDR36, NTF4, TBK1,[18] and RPGRIP1,[19] although most
cases of glaucoma do not involve these genetic mutations. Normal-tension glaucoma, which
comprises one-third of POAG, is also associated with genetic mutations
(including OPA1and OPTN genes).[20]
Various rare congenital/genetic eye malformations are associated with glaucoma. Occasionally,
failure of the normal third-trimester gestational atrophy of the hyaloid canal and the tunica vasculosa
lentis is associated with other anomalies. Angle closure-induced ocular hypertension and
glaucomatous optic neuropathy may also occur with these anomalies, [21][22][23] and has been modelled
in mice.[24]
Other[edit]
Other factors can cause glaucoma, known as "secondary glaucoma", including prolonged use
of steroids (steroid-induced glaucoma); conditions that severely restrict blood flow to the eye, such
as severe diabetic retinopathy and central retinal vein occlusion (neovascular glaucoma); ocular
trauma (angle-recession glaucoma); and inflammation of the middle layer of the pigmented vascular
eye structure (uveitis), known as uveitic glaucoma.
Pathophysiology[edit]
The underlying cause of open-angle glaucoma remains unclear. Several theories exist on its exact
etiology. However, the major risk factor for most glaucomas and the focus of treatment is increased
intraocular pressure. Intraocular pressure is a function of production of liquid aqueous humor by
the ciliary processes of the eye, and its drainage through the trabecular meshwork. Aqueous humor
flows from the ciliary processes into the posterior chamber, bounded posteriorly by the lens and
the zonules of Zinn, and anteriorly by the iris. It then flows through the pupil of the iris into
the anterior chamber, bounded posteriorly by the iris and anteriorly by the cornea. From here, the
trabecular meshwork drains aqueous humor via the scleral venous sinus (Schlemm's canal)
into scleral plexuses and general blood circulation. [25]
In open/wide-angle glaucoma, flow is reduced through the trabecular meshwork, due to the
degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the
aqueous humor. Loss of aqueous humor absorption leads to increased resistance and thus a
chronic, painless buildup of pressure in the eye. [26]
In close/narrow-angle, the iridocorneal angle is completely closed because of forward displacement
of the final roll and root of the iris against the cornea, resulting in the inability of the aqueous fluid to
flow from the posterior to the anterior chamber and then out of the trabecular network. This
accumulation of aqueous humor causes an acute increase in pressure and pain.
The inconsistent relationship of glaucomatous optic neuropathy with increased intraocular pressure
has provoked hypotheses and studies on anatomic structure, eye development, nerve compression
trauma, optic nerve blood flow, excitatory neurotransmitter, trophic factor, retinal ganglion cell/axon
degeneration, glial support cell, immune system, aging mechanisms of neuron loss, and severing of
the nerve fibers at the scleral edge. [27][28][29][30][31][32][33][34][35][36][37]
Diagnosis[edit]
Screening for glaucoma is usually performed as part of a standard eye examination performed
by optometrists and ophthalmologists. Testing for glaucoma should include measurements of the
intraocular pressure via tonometry,[38] anterior chamber angle examination or gonioscopy, and
examination of the optic nerve to look for any visible damage to it, or change in the cup-to-disc
ratio and also rim appearance and vascular change. A formal visual field test should be performed.
The retinal nerve fiber layer can be assessed with imaging techniques such as optical coherence
tomography, scanning laser polarimetry, and/or scanning laser ophthalmoscopy (Heidelberg retinal
tomogram).[39][40][41]
Owing to the sensitivity of all methods of tonometry to corneal thickness, methods such as
Goldmann tonometry should be augmented with pachymetry to measure the central corneal
thickness (CCT). A thicker-than-average cornea can result in a pressure reading higher than the
'true' pressure whereas a thinner-than-average cornea can produce a pressure reading lower than
the 'true' pressure.
Because pressure measurement error can be caused by more than just CCT (i.e., corneal hydration,
elastic properties, etc.), it is impossible to 'adjust' pressure measurements based only on CCT
measurements. The frequency doubling illusion can also be used to detect glaucoma with the use of
a frequency doubling technology perimeter. [42]
Examination for glaucoma also could be assessed with more attention given to sex, race, history of
drug use, refraction, inheritance and family history. [39]
Glaucoma tests[43][44]
What test
How it is accomplished
examines
Gonioscopy Angle in the eye Eyedrops are used to numb the eye. A hand-held contact
where the iris meets lens with a mirror is placed gently on the eye to allow
the cornea the examiner to see the angle between the cornea and
the iris.
Thickness of the Using one of several techniques, the nerve fibers are
Nerve fiber analysis
nerve fiber layer examined.
High-tension glaucoma
Low-tension glaucoma
Pigmentary glaucoma
Exfoliation glaucoma, also known as pseudoexfoliative
glaucoma or glaucoma capsulare
Primary juvenile glaucoma
Primary angle closure glaucoma is caused by contact
between the iris and trabecular meshwork, which in turn
obstructs outflow of the aqueous humor from the eye. This
contact between iris and trabecular meshwork (TM) may
gradually damage the function of the meshwork until it fails to
keep pace with aqueous production, and the pressure rises. In
over half of all cases, prolonged contact between iris and TM
causes the formation of synechiae (effectively "scars").
These cause permanent obstruction of aqueous outflow. In
some cases, pressure may rapidly build up in the eye, causing
pain and redness (symptomatic, or so-called "acute" angle
closure). In this situation, the vision may become blurred, and
halos may be seen around bright lights. Accompanying
symptoms may include a headache and vomiting.
Diagnosis is made from physical signs and symptoms: pupils
mid-dilated and unresponsive to light, cornea edematous
(cloudy), reduced vision, redness, and pain. However, the
majority of cases are asymptomatic. Prior to the very severe
loss of vision, these cases can only be identified by
examination, generally by an eye care professional.
Once any symptoms have been controlled, the first line (and
often definitive) treatment is laser iridotomy. This may be
performed using either Nd:YAG or argon lasers, or in some
cases by conventional incisional surgery. The goal of treatment
is to reverse and prevent, contact between the iris and
trabecular meshwork. In early to moderately advanced cases,
iridotomy is successful in opening the angle in around 75% of
cases. In the other 25%, laser iridoplasty, medication
(pilocarpine) or incisional surgery may be required.
Primary open-angle glaucoma is when optic nerve damage
results in a progressive loss of the visual field. [47] This is
associated with increased pressure in the eye. Not all people
with primary open-angle glaucoma have eye pressure that is
elevated beyond normal, but decreasing the eye pressure
further has been shown to stop progression even in these
cases.
The increased pressure is caused by trabecular meshwork
blockage. Because the microscopic passageways are blocked,
the pressure builds up in the eye and causes imperceptible very
gradual vision loss. Peripheral vision is affected first, but
eventually the entire vision will be lost if not treated.
Diagnosis is made by looking for cupping of the optic nerve.
Prostaglandin agonists work by opening uveoscleral
passageways. Beta-blockers, such as timolol, work by
decreasing aqueous formation. Carbonic anhydrase inhibitors
decrease bicarbonate formation from ciliary processes in the
eye, thus decreasing the formation of Aqueous humor.
Parasympathetic analogs are drugs that work on the trabecular
outflow by opening up the passageway and constricting the
pupil. Alpha 2 agonists (brimonidine, apraclonidine) both
decrease fluid production (via. inhibition of AC) and increase
drainage.
Developmental glaucoma[edit]
Developmental glaucoma (Q15.0)
Inflammatory glaucoma
Phacogenic glaucoma
Hyphema
Hemolytic glaucoma, also known as erythroclastic glaucoma
Traumatic glaucoma
Screening[edit]
The United States Preventive Services
Task Force as of 2013 states there is
insufficient evidence to recommend for
or against screening for glaucoma.
[51]
Therefore, there is no national
screening program in the US.
Screening, however, is recommended
starting at age 40 by the American
Academy of Ophthalmology.[2]
There is a glaucoma screening
program in the UK. Those at risk are
advised to have a dilated eye
examination at least once a year.[52]
Treatment[edit]
The modern goals of glaucoma
management are to avoid
glaucomatous damage and nerve
damage, and preserve visual field and
total quality of life for patients, with
minimal side effects.[53][54] This requires
appropriate diagnostic techniques and
follow-up examinations, and judicious
selection of treatments for the
individual patient. Although intraocular
pressure is only one of the major risk
factors for glaucoma, lowering it via
various pharmaceuticals and/or
surgical techniques is currently the
mainstay of glaucoma treatment.
Vascular flow and neurodegenerative
theories of glaucomatous optic
neuropathy have prompted studies on
various neuroprotective therapeutic
strategies, including nutritional
compounds, some of which may be
regarded by clinicians as safe for use
now, while others are on trial.
Medication[edit]
Latanoprost
Prognosis[edit]
In open-angle glaucoma, the typical
progression from normal vision to
complete blindness takes about 25
years to 70 years without treatment,
depending on the method of estimation
used.[83] The intraocular pressure can
also have an effect, with higher
pressures reducing the time until
blindness.[84]
Epidemiology[edit]
History[edit]
The association of elevated intraocular
pressure (IOP) and the eye disease
glaucoma was first described by
Englishman Richard Bannister in 1622:
"...that the Eye be grown more solid
and hard, then naturally it should be...".
[91]
Angle-closure glaucoma was treated
with cataract extraction by John Collins
Warren in Boston as early as 1806.
[92]
The invention of the
ophthalmoscope by Hermann
Helmholtz in 1851 enabled
ophthalmologists for the first time to
identify the pathological hallmark of
glaucoma, the excavation of the optic
nerve head due to retinal ganglion cell
loss. The first reliable instrument to
measure intraocular pressure was
invented by Norwegian
ophthalmologist Hjalmar August
Schiøtz in 1905. About half a century
later, Hans Goldmann in Berne,
Switzerland, developed his applanation
tonometer which still today - despite
numerous new innovations in
diagnostics - is considered the gold
standard of determining this crucial
pathogenic factor. In the late 20th
century, further pathomechanisms
beyond elevated IOP were discovered
and became the subject of research
like insufficient blood supply – often
associated with low or irregular blood
pressure – to the retina and optic
nerve head.[93] The first drug to reduce
IOP, pilocarpine, was introduced in the
1870s. Early surgical techniques like
iridectomy and fistulating methods
have recently been supplemented by
less invasive procedures like small
implants, a range of options now
widely called MIGS (micro-invasive
glaucoma surgery).
Etymology[edit]
The word "glaucoma" comes from
the Greek γλαύκωμα,[94][95] a derivative
of γλαυκóς,[96] which commonly
described the color of eyes which were
not dark (i.e. blue, green, light gray).
Eyes described as γλαυκóς due to
disease might have had a gray
cataract in the Hippocratic era, or, in
the early Common Era, the greenish
pupillary hue sometimes seen in angle-
closure glaucoma.[9][97]
Research[edit]
Scientists track eye movements in
glaucoma patients to check vision
impairment while driving
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External links[edit]
Classification V · T · D
ICD-10
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MeSH:
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eMedic
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Adnexa
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Globe
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Pathways
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Infections
h85055227
21210-5
027278808
1935553n (data)
569850
529246
Categories:
Glaucoma
Blindness
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All forms of conjunctivitis — including bacterial, viral, allergic and other types — involve
inflammation of the transparent, mucous membrane (conjunctiva) covering the white part of the
eye or sclera.
Infectious causes of an inflamed eye and conjunctivitis include bacteria, viruses and fungi. Non-
infectious causes include allergies, foreign bodies and chemicals.
The phrase "pink eye" is commonly used to refer to conjunctivitis, because pinkness or redness
of the conjunctiva is one of the most noticeable symptoms.
Types Of Conjunctivitis
Bacterial conjunctivitis is a common type of pink eye, caused by bacteria that infect the eye
through various sources of contamination. The bacteria can be spread through contact with an
infected individual, exposure to contaminated surfaces or through other means such as sinus or
ear infections.
Allergic conjunctivitis can result when your eyes encounter a substance to which they are overly
sensitive, such as pollen in the air.
The most common types of bacteria that cause bacterial conjunctivitis include Staphylococcus
aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa.
Bacterial conjunctivitis usually produces a thick eye discharge or pus and can affect one or both
eyes.
As with any bacterial infection, antibiotics are required to eliminate the bacteria. Treatment of
bacterial conjunctivitis is typically accomplished with topical antibiotic eye drops and/or eye
ointments. The treatment usually takes from one to two weeks, depending on the severity of the
infection.
Viral conjunctivitis is another common type of pink eye that is highly contagious, because
airborne viruses can be spread through sneezing and coughing. Viral conjunctivitis also can
accompany common viral upper respiratory infections such as measles, the flu or the common
cold.
Viral conjunctivitis usually produces a watery discharge. Typically the infection starts in one eye
and quickly spreads to the other eye.
Unlike with bacterial infections, antibiotics will not work against viruses. No eye drops or
ointments are effective against the common viruses that cause viral conjunctivitis. But viral
conjunctivitis is self-limited, which means it will go away by itself after a short time.
Typically with viral conjunctivitis, the third through the fifth days are the worst. After that, eyes
begin to improve on their own.
Treatment of viral conjunctivitis usually involves supportive therapies, such as eye drops, that
help reduce the symptoms: for example, vasoconstrictors to whiten the eye, decongestants to
reduce the surface swelling and antihistamines to reduce occasional itching. Treatments usually
are continued for one to two weeks, depending on the severity of the infection.
Gonococcal and chlamydial conjunctivitis are bacterial forms related to infections from
sexually transmitted diseases including gonorrhea and chlamydia. Newborn babies may be
exposed when they pass through the birth canal of an infected mother. Trachoma is a form of
chlamydial infection that causes scarring on the eye's surface. Trachoma is the world's leading
cause of preventable blindness.
Neonatal conjunctivitis found in newborn babies can cause blindness when left untreated. Up
to 10 percent of all pregnant women in the United States have a sexually transmitted chlamydial
infection. If these infections are untreated in mothers, the possibility that a newborn infant will
develop a related eye infection ranges from 10 percent to 20 percent.*
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Another type of sexually transmitted disease related to the herpes simplex virus type 2 found in
the genital area can infect eyes of infants as they are born. Herpes simplex virus type 1, a
cause of cold sores on the mouth, also can cause a type of eye herpes that results in pink eye.
If you are pregnant and suspect you may have a sexually transmitted disease, you need to be
checked and possibly treated for any infection before the birth of your baby.
In the United States, an antibiotic ointment often is applied as a basic standard of care for
newborn infants, to help prevent the possibility of certain eye infections.
Allergic conjunctivitis caused by eye allergies is very common. Eye allergies, like other types,
can be triggered by allergens including pollen, animal dander and dust mites.
The most common symptom of allergic conjunctivitis is itchy eyes, which may be relieved with
special eye drops containing antihistamines to control allergic reactions. These eye drops are
available both over the counter and by prescription.
Avoiding the allergen is also important in the treatment of allergic conjunctivitis. Allergic
conjunctivitis can be seasonal or perennial (year-round), depending on the allergen causing the
reaction.
Giant papillary conjunctivitis (GPC) usually involves both eyes and often affects soft contact
lens wearers. This condition may cause contact lens intolerance, itching, a heavy discharge,
tearing and red bumps on the underside of the eyelids.
You'll need to stop wearing your contact lenses, at least for a little while. Your eye doctor may
also recommend that you switch to a different type of contact lens, to reduce the chance of the
conjunctivitis coming back.
For example, you might need to switch from soft contacts to gas permeable ones or vice versa.
Or you might need to try a type of lens that you replace more frequently, such as disposable
contact lenses. GPC can also result from artificial eyes (prosthetics), stitches and more. Your
eye doctor will decide if removal is appropriate.
Non-infectious conjunctivitis from eye irritation causing pink eye symptoms that can result
from many sources, including smoke, diesel exhaust, perfumes and certain chemicals. Some
forms of conjunctivitis also result from sensitivity to certain ingested substances, including herbs
such as eyebright and turmeric.**
Certain forms of pink eye, including giant papillary conjunctivitis, can be caused by the eye's
immune responses, such as a reaction to wearing contact lenses or ocular prosthetics (artificial
eyes). A reaction to preservatives in eye drops or ointments also can cause toxic
conjunctivitis.
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Keratoconus treatment - Intacs
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Pollen count map
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CATARACTS
About cataract surgery
About intraocular lenses / IOLs
Multifocal IOLs
How to choose a cataract surgeon
Risks & complications
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Dry Eyes
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DRY EYES
About dry eye syndrome
Answers from a dry eye expert
Contact lenses for dry eyes
Dry eye infographic - sponsored
Flaxseed oil and fish oil for dry eyes
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Low Vision
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LOW VISION
Magnifiers - buyer's guide
Finding a low vision doctor
How to help someone with low vision
Vision aids for distance viewing
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Sports Vision
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SPORTS VISION
Contact lenses for sports
Protective sports eyewear
Choosing the right lens tint for your sport
Eyeglasses for sports
12 tips for buying ski goggles
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Eye Safety
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EYE SAFETY
Eye safety basics
How to tell if an eye injury is serious
Getting the right safety glasses
[Video] How to prevent eye injuries
Toys to avoid to keep kids' eyes safe
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Children's Vision
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CHILDREN'S VISION
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8 warning signs of vision problems in kids
Kids & computer vision syndrome
Vision therapy for children
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Teens
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TEENS
5 tips for choosing eyeglasses
Sunglasses - trends for teens
Nutrition for your eyes
Asking your parents for contacts? What to know
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Vision Over 40
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VISION OVER 40
Pros and cons of reading glasses
Multifocal contact lenses
Safety tips for improving night driving
Combining options for presbyopia
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Vision Over 60
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VISION OVER 60
How vision changes as you age
8 ways to protect your eyesight
How good nutrition protects aging eyes
Senior eye exams at no cost
Safe driving after 60
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Cosmetic Procedures
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COSMETIC EYE SURGERY
Botox FAQ
Eyelid surgery / blepharoplasty
Latisse for eyelashes - is it safe?
Puffy eyes & dark circles
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Vision Insurance
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VISION INSURANCE
How to choose a plan
How to use vision insurance
Glossary of vision insurance terms
Medicare / Medicaid vision benefits
VSP - how to make the most of your benefits
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Resources
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RESOURCES
Eye anatomy / parts of the eye
Glossary of vision terms
Buy smarter - Be a better eye care consumer
How to put in eye drops
Learn about these great vision charities
Mobile apps for your eyes and vision
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